Humorism

Humorism, the humoral theory, or

humoralism, was a system of medicine detailing a
supposed makeup and workings of the human body,
adopted by Ancient Greek and Roman physicians and
philosophers.

Humorism began to fall out of favor in the 1850s with

the advent of germ theory, which was able to show
that many diseases previously thought to be humoral
were in fact caused by microbes.

Contents
Origin
Four humors 16th century illustration of the four
Blood humors: Flegmat (phlegm),
Sanguin (blood), Coleric (yellow
Yellow bile
bile) and Melanc (black bile)
Black bile
Phlegm
Humor production
Unification of humorism with Empedocles model
Influence and legacy
Islamic medicine
Perso-Arabic and Indian medicine
Western medicine
Modern use
Culture
See also
References
Bibliography
External links

Origin
:
 The concept of "humors" (chemical systems regulating human behaviour) became more
prominent from the writing of medical theorist Alcmaeon of Croton (c. 540–500 BC). His
list of humors was longer and included fundamental elements described by Empedocles,
such as water, air, earth, fire, etc.. The concept of "humors" may have origins in Ancient
Egyptian medicine,[1] or Mesopotamia,[2] though it was not systemized until ancient
Greek thinkers. The word humor is a translation of Greek χυµός,[3] chymos (literally juice
or sap, metaphorically flavor). Ancient Indian Ayurveda medicine had developed a theory
of three doshas (doṣas),[4] which they linked with the five elements (pañca-bhūta): earth,
water, fire, air, and space.[4]

Hippocrates is usually credited with applying this idea to medicine. In contrast to

Alcmaeon, Hippocrates suggested that humors are the vital bodily fluids: blood, phlegm,
yellow bile, and black bile. Alcmaeon and Hippocrates posited that an extreme excess or
deficiency of any of the humors (bodily fluid) in a person can be a sign of illness.
Hippocrates, and then Galen, suggested that a moderate imbalance in the mixture of
these fluids produces behavioral patterns.[5] One of the treatises attributed to
Hippocrates, On the Nature of Man, describes the theory as follows:

The Human body contains blood, phlegm, yellow bile, and black bile. These
are the things that make up its constitution and cause its pains and health.
Health is primarily that state in which these constituent substances are in the
correct proportion to each other, both in strength and quantity, and are well
mixed. Pain occurs when one of the substances presents either a deficiency or
an excess, or is separated in the body and not mixed with others.[6]

Although the theory of the four humors does appear in some Hippocratic texts, other
Hippocratic writers accepted the existence of only two humors, while some refrained
from discussing the humoral theory at all.[7] Humoralism, or the doctrine of the four
temperaments, as a medical theory retained its popularity for centuries, largely through
the influence of the writings of Galen (129–201 AD). Hippocrates' theory of four humors
was linked with the popular theory of the four elements (earth, fire, water, and air)
proposed by Empedocles, but this link was not proposed by Hippocrates or Galen, who
referred primarily to bodily fluids. While Galen thought that humors were formed in the
body, rather than ingested, he believed that different foods had varying potential to act
upon the body to produce different humors. Warm foods, for example, tended to produce
yellow bile, while cold foods tended to produce phlegm. Seasons of the year, periods of
life, geographic regions, and occupations also influenced the nature of the humors
formed. As such, certain seasons and geographic areas were understood to cause
imbalances in the humors, leading to varying types of disease across time and place. For
example, cities exposed to hot winds were seen as having higher rates of digestive
problems as a result of excess phlegm running down from the head, while cities exposed
to cold winds were associated with diseases of the lungs, acute diseases, and "hardness of
the bowels," as well as opthalmies (issues of the eyes), and nosebleeds. Cities to the west,
meanwhile, were believed to produce weak, unhealthy, pale people that were subject to all
manners of disease.[8] In the treatise, Airs, Waters, Places, a Hippocratic physician is
:
 described arriving to an unnamed city where they test various factors of nature including
the wind, water, and soil to predict the direct influence on the diseases specific to the city
based on the season and the individual.[9]

The imbalance of humors, or dyscrasia, was thought

to be the direct cause of all diseases. Health was
associated with a balance of humors, or eucrasia. The
qualities of the humors, in turn, influenced the nature
of the diseases they caused. Yellow bile caused warm
diseases and phlegm caused cold diseases. In On the
Temperaments, Galen further emphasized the
importance of the qualities. An ideal temperament
involved a proportionally balanced mixture of the four
qualities. Galen identified four temperaments in
which one of the qualities (warm, cold, moist, or dry)
predominated, and four more in which a combination
of two (warm and moist, warm and dry, cold and dry,
or cold and moist) dominated. These last four, named
for the humors with which they were associated—
The four temperaments as
sanguine, choleric, melancholic and phlegmatic— depicted in an 18th-century
eventually became better known than the others. woodcut: phlegmatic, choleric,
While the term temperament came to refer just to sanguine and melancholic.
psychological dispositions, Galen used it to refer to
bodily dispositions, which determined a person's
susceptibility to particular diseases, as well as behavioral and emotional inclinations.

Disease could also be the result of the "corruption" of one or more of the humors, which
could be caused by environmental circumstances, dietary changes, or many other
factors.[10] These deficits were thought to be caused by vapors inhaled or absorbed by the
body. Greeks and Romans, and the later Muslim and Western European medical
establishments that adopted and adapted classical medical philosophy, believed that each
of these humors would wax and wane in the body, depending on diet and activity. When a
patient was suffering from a surplus or imbalance of one of the four humors, then said
patient's personality and/or physical health could be negatively affected.

Four humors
Even though humorism theory had several models that used 2, 3, and 5 components, the
most famous model consists of the four humors described by Hippocrates and developed
further by Galen. The four humors of Hippocratic medicine are black bile (Greek: µέλαινα
χολή, melaina chole), yellow bile (Greek: ξανθη χολή, xanthe chole), phlegm (Greek:
φλέγµα, phlegma), and blood (Greek: αἷµα, haima). Each corresponds to one of the
traditional four temperaments. Based on Hippocratic medicine, it was believed that for a
body to be healthy, the four humors should be balanced in amount and strength.[11] The
proper blending and balance of the four humors was known as "eukrasia".[12]
:
 Humorism theory was improved by Galen, who incorporated his understanding of the
humors into his interpretation of the human body. He believed the interactions of the
humors within the body were the key to investigating the physical nature and function of
the organ systems. Galen combined his interpretation of the humors with his collection of
ideas concerning nature from past philosophers in order to find conclusions about how
the body works. For example, Galen maintained the idea of the presence of the Platonic
tripartite soul, which consisted of “thumos (spiritedness), epithumos (directed
spiritedness, i.e., desire), and Sophia (wisdom).” [13] Through this, Galen found a
connection between these three parts of the soul and the three major organs that were
recognized at the time: the brain, the heart, and the liver. [13] This idea of connecting vital
parts of the soul to vital parts of the body was derived from Aristotle’s sense of explaining
physical observations, and Galen utilized it to build his view of the human body. The
organs (named organa) had specific functions (called chreiai) that contributed to the
maintenance of the human body, and the expression of these functions is shown in
characteristic activities (called energeiai) of a person. [14] While the correspondence of
parts of the body to the soul was an influential concept, Galen decided that the interaction
of the four humors with natural bodily mechanisms were responsible for human
development and this connection inspired his understanding of the nature of the
components of the body.

Galen recalls the correspondence between humors and seasons in his On the Doctrines of
Hippocrates and Plato, and says that, "As for ages and the seasons, the child (παῖς)
corresponds to spring, the young man (νεανίσκος) to summer, the mature man
(παρακµάζων) to autumn, and the old man (γέρων) to winter".[15] He also related a
correspondence between humors and seasons based on the properties of both. Blood, as a
humor, was considered hot and wet. This gave it a correspondence to spring. Yellow bile
was considered hot and dry, which related it to summer. Black bile was considered cold
and dry, and thus related to autumn. Phlegm, cold and wet, was related to winter.[16]

Galen also believed that the characteristics of the soul follow the mixtures of the body, but
he did not apply this idea to the Hippocratic humors. He believed that phlegm did not
influence character. In his On Hippocrates' The Nature of Man, Galen stated: "Sharpness
and intelligence (ὀξὺ καὶ συνετόν) are caused by yellow bile in the soul, perseverance and
consistency (ἑδραῖον καὶ βέβαιον) by the melancholic humor, and simplicity and naivety
(ἁπλοῦν καὶ ἠλιθιώτερον) by blood. But the nature of phlegm has no effect on the
character of the soul (τοῦ δὲ φλέγµατος ἡ φύσις εἰς µὲν ἠθοποιῗαν ἄχρηστος)."[17] He
further said that blood is a mixture of the four elements: water, air, fire, and earth.

These terms only partly correspond to modern medical terminology, in which there is no
distinction between black and yellow bile, and phlegm has a very different meaning. It
was believed that the humors were the basic substances from which all liquids in the body
were made. Robin Fåhræus (1921), a Swedish physician who devised the erythrocyte
sedimentation rate, suggested that the four humors were based upon the observation of
blood clotting in a transparent container. When blood is drawn in a glass container and
left undisturbed for about an hour, four different layers can be seen: a dark clot forms at
:
 the bottom (the "black bile"); above the clot is a layer of red blood cells (the "blood");
above this is a whitish layer of white blood cells (the "phlegm"); the top layer is clear
yellow serum (the "yellow bile").[18]

Many Greek texts were written during the golden age of the theory of the four humors in
Greek medicine after Galen. One of those texts was an anonymous treatise called On the
Constitution of the Universe and of Man, published in the mid-19th century by J.L.
Ideler. In this text, the author establishes the relationship between elements of the
universe (air, water, earth, fire) and elements of the man (blood, yellow bile, black bile,
phlegm).[19] He said that:

The people who have red blood are friendly. They joke and laugh about their bodies,
and they are rose tinted, slightly red, and have pretty skin.
The people who have yellow bile are bitter, short tempered, and daring. They appear
greenish and have yellow skin.
The people who are composed of black bile are lazy, fearful, and sickly. They have
black hair and black eyes.
Those who have phlegm are low spirited, forgetful, and have white hair.

Blood

The blood was believed to be the product of food digestion. It was thought that the
nutritional value of the blood was the source of energy for the body and the soul. Blood
was believed to consist of small proportional amounts of the other three humors. This
meant that taking a blood sample would allow for determination of the balance of the four
humors in the body. [20] It was associated with a sanguine nature (enthusiastic, active,
and social).[21][22]: 103–05  The seasonal association of blood is the spring because the
natural characteristics found in individuals was associated with being hot and wet.[23]

Yellow bile

Yellow bile was associated with a choleric nature (ambitious, decisive, aggressive, and
short-tempered).[24] It was thought to be fluid found within the gallbladder, however it
could also be found in excretions such as vomit or feces. [20] The associated qualities for
yellow bile are hot and dry with the natural association of summer and fire. It was
believed that an excess of this humor in an individual would result in emotional
irregularities such as increased anger or behaving irrationally.[25]

Black bile
Black bile was associated with a melancholy nature, the word "melancholy" itself deriving
from the Greek for "black bile", µέλαινα χολή (melaina kholé). Depression was attributed
to excess or unnatural black bile secreted by the spleen.[26] Cancer was also attributed to
:
 an excess of black bile concentrated in a specific area.[27] The seasonal association of
black bile was to autumn as the cold and dry characteristics of the season reflect the
nature of man.[28]

Phlegm

Phlegm was associated with a phlegmatic nature, thought to be associated with reserved
behavior.[29] The phlegm of humorism is far from phlegm as it is defined today. Phlegm
was used as a general term to describe white or colorless secretions such as pus, mucus,
saliva, or sweat. [20] Phlegm was also associated with the brain, possibly due to the color
and consistency of brain tissue. [20] The French physiologist and Nobel laureate Charles
Richet, when describing humorism's "phlegm or pituitary secretion" in 1910, asked
rhetorically, "this strange liquid, which is the cause of tumours, of chlorosis, of
rheumatism, and cacochymia – where is it? Who will ever see it? Who has ever seen it?
What can we say of this fanciful classification of humors into four groups, of which two
are absolutely imaginary?"[30] The seasonal association of phlegm is winter due to the
natural properties of being cold and wet.[31]

Humor production
Humors were believed to be produced via digestion as the final products of hepatic
digestion. Digestion is a continuous process taking place in every animal, and it can be
divided into four sequential stages.[32] The gastric digestion stage, the hepatic digestion
stage, the vascular digestion stage, and the tissue digestion stage. Each stage digests food
until it becomes suitable for use by the body. In gastric digestion, food is made into
chylous, which is suitable for the liver to absorb and carry on digestion. Chylous is
changed into chymous in the hepatic digestion stage. Chymous is composed of the four
humors: blood, phlegm, yellow bile, and black bile. These four humors then circulate in
the blood vessels. In the last stage of digestion, tissue digestion, food becomes similar to
the organ tissue for which it is destined.

If anything goes wrong leading up to the production of humors, there will be an

imbalance leading to disease. Proper organ functioning is necessary in the production of
good humor. The stomach and liver also have to function normally for proper digestion. If
there are any abnormalities in gastric digestion, the liver, blood vessels, and tissues
cannot be provided with the raw chylous, which can cause abnormal humor and blood
composition. A healthy functioning liver is not capable of converting abnormal chylous
into normal chylous and normal humors.

Humors are the end product of gastric digestion, but they are not the end product of the
digestion cycle, so an abnormal humor produced by hepatic digestion will affect other
organs that are working towards the digestion of food in the digestion cycle.

Unification of humorism with Empedocles model

:
 Empedocles's theory suggested that there are four elements: earth, fire, water, and air,
with the earth producing the natural systems. Since this theory was influential for
centuries, later scholars paired qualities associated with each humor as described by
Hippocrates/Galen with seasons and "basic elements" as described by Empedocles.[33]

The following table shows the four humors with their corresponding elements, seasons,
sites of formation, and resulting temperaments:[34]

Humor Season Ages Element Organ Qualities Temperament

Blood Spring Infancy Air Liver Warm and moist Sanguine

Yellow bile Summer Youth Fire Gallbladder Warm and dry Choleric

Black bile Autumn Adulthood Earth Spleen Cold and dry Melancholic

Phlegm Winter Old age Water Brain/Lungs Cold and moist Phlegmatic

Influence and legacy

Islamic medicine

Medieval medical tradition in the Golden Age of Islam adopted the theory of humorism
from Greco-Roman medicine, notably via the Persian polymath Avicenna's The Canon of
Medicine (1025). Avicenna summarized the four humors and temperaments as
follows:[35]
:
 Avicenna's (ibn Sina) four humors and temperaments

Evidence Hot Cold Moist Dry

Fevers related to
Morbid Inflammations
serious humor, Lassitude Loss of vigour
states become febrile
rheumatism

Functional Deficient digestive

Deficient energy Difficult digestion
power power

Bitter taste,
Subjective Lack of desire for Mucoid salivation, Insomnia,
excessive thirst,
sensations fluids sleepiness wakefulness
burning at cardia

Diarrhea, swollen
Physical High pulse rate, Rough skin,
Flaccid joints eyelids, rough skin,
signs lassitude acquired habit
acquired habit

Calefacients Infrigidants Dry regimen

Foods and harmful, harmful, harmful,
Moist articles harmful
medicines infrigidants[36] calefacients humectants
beneficial beneficial beneficial

Relation to
Worse in summer Worse in winter Bad in autumn
weather

Perso-Arabic and Indian medicine

The Unani school of medicine, practiced in Perso-Arabic countries, India, and Pakistan, is
based on Galenic and Avicennian medicine in its emphasis on the four humors as a
fundamental part of the methodologic paradigm.

Western medicine

The humoralist system of medicine was highly individualistic, for all patients were said to
have their own unique humoral composition.[37] From Hippocrates onward, the humoral
theory was adopted by Greek, Roman and Islamic physicians, and dominated the view of
the human body among European physicians until at least 1543 when it was first seriously
challenged by Andreas Vesalius. Vesalius mostly criticized Galen's theories of human
anatomy and not the chemical hypothesis of behavioural regulation (temperament).
However, some believe that theory of humors was cast into the underside of science in
1628 by the findings of William Harvey (also mostly criticizing the anatomy theory of
Galen) and by Rudolf Virchow's theories of cellular pathology in 1858.

Typical 18th-century practices such as bleeding a sick person or applying hot cups to a
person were based on the humoral theory of imbalances of fluids (blood and bile in those
cases). Ben Jonson wrote humor plays, where types were based on their humoral
complexion. Methods of treatment like bloodletting, emetics and purges were aimed at
:
 expelling a surplus of a humor.[38] Other methods used herbs and foods associated with a
particular humor to counter symptoms of disease, for instance: people who had a fever
and were sweating were considered hot and wet and therefore given substances
associated with cold and dry. Paracelsus further
developed the idea that beneficial medical substances
could be found in herbs, minerals and various
alchemical combinations thereof. These beliefs were
the foundation of mainstream Western medicine well
into the 17th century. Specific minerals or herbs were
used to treat ailments simple to complex, from an
uncomplicated upper respiratory infection to the
plague. For example, chamomile was used to decrease
heat, and lower excessive bile humor. Arsenic was
used in a poultice bag to 'draw out' the excess
humor(s) that led to symptoms of the plague.
Apophlegmatisms, in pre-modern medicine, were
medications chewed in order to draw away phlegm The four humors and their
and humors. qualities

Although advances in cellular pathology and

chemistry criticized humoralism by the 17th century, the theory had dominated Western
medical thinking for more than 2,000 years.[39][40] Only in some instances did the theory
of humoralism wane into obscurity. One such instance occurred in the sixth and seventh
centuries in the Byzantine Empire when traditional secular Greek culture gave way to
Christian influences. Though the use of humoralist medicine continued during this time,
its influence was diminished in favor of religion.[41] The revival of Greek humoralism,
owing in part to changing social and economic factors, did not begin until the early ninth
century.[42] Use of the practice in modern times is pseudoscience.[43]

Modern use

Modern medicine refers to humoral immunity or humoral regulation when describing

substances such as hormones and antibodies, but this is not a remnant of the humor
theory. It is merely a literal use of humoral, i.e. pertaining to bodily fluids (such as blood
and lymph).

The concept of humorism was not definitively disproven until 1858.[39][40] There were no
studies performed to prove or disprove the impact of dysfunction in known bodily organs
producing named fluids (humors) on temperament traits simply because the list of
temperament traits was not defined up until the end of the 20th century.

Culture
:
 Theophrastus and others developed a set of characters based on the humors. Those with
too much blood were sanguine. Those with too much phlegm were phlegmatic. Those
with too much yellow bile were choleric, and those with too much black bile were
melancholic. The idea of human personality based on humors contributed to the
character comedies of Menander and, later, Plautus. Through the neo-classical revival in
Europe, the humor theory dominated medical practice, and the theory of humoral types
made periodic appearances in drama. The humors were an important and popular
iconographic theme in European art, found in paintings, tapestries,[44] and sets of prints.

The humors can be found in Elizabethan works, such as in Taming of the Shrew, in which
the character Petruchio pretends to be irritable and angry to show Katherina what it is
like being around a disagreeable person. He yells at the servants for serving mutton, a
choleric food, to two people who are already choleric.

Foods in Elizabethan times were believed to have an affinity with one of these four
humors. A person showing signs of phlegmatism might have been served wine (a choleric
drink and the direct opposite humor to phlegmatic) to balance this.

See also
Classical element
Comedy of humours
Five temperaments
Three Doshas of Ayurveda
Wu Xing (Five Principles of Chinese philosophy)
Mitama

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External links
BBC Radio4's In Our Time. Episode on the four humors (http://www.bbc.co.uk/radio4/
history/inourtime/inourtime_20071220.shtml) in MP3 format, 45 minutes.
Article from 'Phisick'. Humoral Theory (http://phisick.com/article/humoral-theory/)

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